VAQ 1



VAQ 1

A 14 year old girl is being assessed in your ED for possible envenomation after a snake bite.

a. Outline the components of the test shown in this photograph, briefly explaining its method of use. 50%

b. What are the limitations of this test? 50%

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2005.1 VAQ 3

A patient is being assessed in your emergency department following an overdose of paracetamol. You are told the paracetamol level is 100 micrograms/ml (630 micromol/L) and are given a paracetamol nomogram.

What factors do you need to consider or determine in order to interpret this result? (100%)

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FACEM VAQ Exam 2005.1 – Question 3

• The overall pass rate for this question was 31 / 44 (70.5%).

• The picture is of a paracetamol nomogram with 2 “treatment” lines.

• A high level of knowledge was expected in answers to this question on a topic that is frequently encountered in emergency practice.

• An awareness of the validity of the nomogram with its derivation from a study of single ingestions at a known time was expected as well as an understanding of the meaning of the 2 treatment lines.

• The result also needed interpretation in the context of patient factors such as age, co-morbidities, co-ingestants, paracetamol formulation, multidosing etc.

• Failing answers did not consider enough variables in interpretation of the result and did not mention the nomogram validity.

A 77 year old man presents to your emergency department feeling generally unwell for several days. He is noted to have a pulse rate of 36 beats / minute and is normotensive.

Arterial blood gases and serum biochemical tests are performed

Question

|a. |Describe and interpret the results of his investigations. |(70%) |

|b. |Outline your treatment of his raised digoxin level |(30%) |

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FACEM VAQ Exam 2007.2 – Question 3

• The overall pass rate for this question was 57/77 (74.0%).

• The examiners felt that this was an excellent set of clinical data on which to base a question.

Good answers identified all the major abnormalities plus discussed specific treatments including dialysis, use of digoxin Fab fragments and avoided the use of calcium for the hyperkalemia in the presence of digoxin toxicity

A previously well 2 year old boy is brought to your Emergency Department  by his mother after he ingested 1.8 g of liquid Paracetamol at 0700 that morning. Serum biochemical investigations were performed four hours after the ingestion; it is now 1200. He is asymptomatic with normal vital signs.

|a. |Discuss the utility of the nomogram shown below in this patient |(50%) |

|b. |Outline your disposition |(50%) |

Serum biochemistry results

|  |  |  |  |Normal Range |

|  |Paracetamol |30 |mg/L | ................
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